AUTHOR=Baek Jang-Hyun , Jung Cheolkyu , Kim Byung Moon , Heo Ji Hoe , Kim Dong Joon , Nam Hyo Suk , Kim Young Dae , Lim Eun Hyun , Kim Jun-Hwee , Kim Jun Yup , Kim Jae Hyoung 

TITLE=Combination of Rescue Stenting and Antiplatelet Infusion Improved Outcomes for Acute Intracranial Atherosclerosis-Related Large-Vessel Occlusion

JOURNAL=Frontiers in Neurology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2021.608270

DOI=10.3389/fneur.2021.608270

ISSN=1664-2295

ABSTRACT=Background and Purpose: Intracranial atherosclerosis-related large vessel occlusion caused by in situ thrombo-occlusion (ICAS-LVO) has been regarded an important reason for refractoriness to mechanical thrombectomy (MT). To achieve better outcomes for ICAS-LVO, different endovascular strategies should be explored. We aimed to investigate an optimal endovascular strategy for ICAS-LVO.

Methods: We retrospectively reviewed 3 prospective registries of acute stroke underwent endovascular treatment. Among them, patients with ICAS-LVO were assigned to 4 groups based on their endovascular strategy: (1) MT alone, (2) rescue intracranial stenting after MT failure (MT-RS), (3) glycoprotein IIb/IIIa inhibitor infusion after MT failure (MT-GPI), and (4) a combination of MT-RS and MT-GPI (MT-RS+GPI). Baseline characteristics and outcomes were compared among the groups. To evaluate whether the endovascular strategy resulted in favorable outcome, multivariable analysis was also performed.

Results: A total of 184 patients with ICAS-LVO were included. Twenty-four patients (13.0%) were treated with MT alone, 25 (13.6%) with MT-RS, 84 (45.7%) with MT-GPI, and 51 (27.7%) with MT-RS+GPI. The MT-RS+GPI group showed the highest recanalization efficiency (98.0%). Frequency of patent arteries on follow-up (98.0%, P < 0.001) and favorable outcome (84.3%, P < 0.001) were higher in the MT-RS+GPI group than other groups. The MT-RS+GPI strategy remained an independent factor for favorable outcome (OR, 20.4; 95% CI, 1.97 – 211.4; P = 0.012).

Conclusion: Endovascular strategy was significantly associated with procedural and clinical outcomes in acute stroke by ICAS-LVO. A combination of RS and GPI infusion might be an optimal rescue modality when frontline MT fails.